Monterey County doctors' Medicare payouts revealed

Monterey >> Father and daughter oncologists Jerome and Nancy Rubin were paid more than $2.6 million by Medicare in 2012, according to a database released Wednesday by the Obama administration.

The Rubins were the highest paid by Medicare in the county that year but there were also 54 doctors who were paid more than $300,000.

The top 10 payouts in the county equaled roughly $8.4 million.

The administration said it released the list of reimbursements to "make our healthcare system more transparent, affordable and accountable."

Officials with the American Medical Administration said releasing the data without context would lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.

Jerome Rubin said Wednesday his reimbursement was high because of the drugs needed for chemotherapy — something he needs to reimburse vendors for afterward.

"The margin of what Medicare reimburses for what the cost of the drug is . . . almost a complete wash," he said.

He said many oncologists have gone out of business because reimbursements are too low. Rubin, who has been practicing in Monterey for 40 years, said he was pleased a measure by Rep. Sam Farr, D-Carmel, to increase local payments was signed by President Barack Obama two weeks ago.

The new payment system, which will be phased in over six years starting in 2017, will be based on Metropolitan Statistical Areas, which already are used for Medicare payments to hospitals.

"Sam did a great job in being able to get that," Rubin said.

Until the measure passes, Monterey County is still considered a "rural" county by Medicare standards, meaning doctors in counties classified as "urban" are paid about $3.8 million more a year, according to Farr's office.

Four of the doctors affiliated with Salinas Valley Urology Associates, which is under investigation by the U.S. Office of Inspector General, made the top 20 list in the county.

According to patients who have been interviewed, the investigation appears to focus on whether some of the physicians are illegally profiting by referring patients for services at the urology center.

The founders of the urology center, Stephen Worsham and Aytac Apaydin, earned $893,459 and $580,949, respectively.

A representative of Salinas Valley Urology Associates asked The Herald to email the center data about the reimbursements. A response was not received by press time.

Nationally, the highest payout went to Florida ophthalmologist Salmon Melgen, who received $20.8 million.

An analysis by The Associated Press of the data found of the 825,000 doctors who filed Medicare claims, 344 physicians took in at least $3 million apiece.

About 1 in 4 of the top-paid doctors came from Florida. California, New Jersey, Texas and New York rounded out the list.